When it comes to gut troubles that make you feel especially lousy, irritable bowel syndrome (IBS) ranks pretty high on the list, and as many as 45 million people in the US have it. Though ‘IBS’ is a virtually meaningless catchall phrase that sheds no light on what’s actually causing the symptoms, the struggle is very real – think frequent, gas, recurring abdominal pain, cramps, bloating, constipation, diarrhea, etc.  

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So, what lies beneath all this gut misery? In my experience, and according to a growing number of researchers one of the most common culprits is  ‘dysbiosis,’ also known as an altered, or imbalanced, microbiome. But the good news is that with some gut-focused TLC, IBS is quite treatable, without resorting to a prescription pad. So, how to slay the IBS monster? Start here:

To understand IBS, start with your microbiome.

If your digestive system is humming along nicely, that’s a beautiful thing -- odds are, no major trouble in your gut paradise. For IBS sufferers, those debilitating symptoms are sure-fire signs that your microbiome – the microbial community that lives in the gut and helps keep you well – needs urgent attention.

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IBS sufferers may well be suffering from dysbiosis, a microbial imbalance that can interfere with the body’s ability to extract and effectively use the nutrients from food. It impacts both physical and emotional well-being, shortchanging both body and brain. Making matters worse, from dysbiosis, it’s a hop-skip to a ‘leaky gut,’ aka increased gut permeability, which is where inflammation starts, leading to all sorts of problems throughout the body, including skin conditions like eczema and psoriasis, brain fog, anxiety, depression, sleep issues, auto-immune conditions and accelerated aging, in addition to IBS symptoms.

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The first step to keeping leaky gut at bay is to start embracing prebiotics, the dietary fibers that we humans cannot actually digest. Your gut bacteria feast on the fiber, fermenting it and producing organic acids that help maintain and repair the gut wall, keeping cells tightly-linked and leak-free. Leak-free means partially digested food particles and toxins or metabolites of gut bacteria won’t escape into the bloodstream, nor will they able to increase the risk of IBS.  And a well-fed microbiome means a greater number of bacteria and a more diverse collection of bacterial species, all of which keep the gut healthy and resistant to all manner of gastrointestinal problems.  

So, what’s bugging your microbiome?

When IBS strikes, one of the first questions patients ask, after ‘why me?’, is: ‘what’s making me so sick so often?’ Well, there are a number of triggering and/or aggravating factors at play, and many of them are often overlooked by conventional medicine, or else treated by prescription drugs, which mask the underlying causes rather than addressing them. Just as bad, their effects tend to fade over time, so, if your microbiome is altered or imbalanced, it’s time to root out the most common culprits – the Debilitating Dozen:

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1. Food sensitivities and allergies – that irritate and inflame the gut, setting off an immune response that can bring on a slew of symptoms.
2. Food poisoning – whether a single bad bout or a few light ones, it can derange the bacterial balance in your gut, setting yourself up for IBS.
3. Leaky gut – aka ‘gut permeability,’ enabling toxins to leak out of the gut and into the bloodstream, triggering an immune system overreaction, resulting in IBS symptoms.
4. Bacterial or fungal overgrowth– for example, in the form of small intestinal bacterial overgrowth (SIBO); or small intestinal fungal overgrowth (SIFO), sometimes described as candida or yeast overgrowth.  
5. Parasitic infections – low-grade, untreated parasitic infections, like entamoeba histolytica or giardia, which may clear up on their own but still wind up disrupting bacterial balance.
6. Stress – which can trigger changes in the microbiome associated with poor gastrointestinal health, including lower levels of “good” bacteria and their metabolites, and a less diverse population of bacterial species.
7. Alcohol – even in small amounts (think one drink per day), can lead to changes in gut microbiome composition leading to dysbiosis.
8. Antibiotics – probably the most common cause of an altered microbiome, as they wipe out whatever gut bacteria are sensitive to them, your beneficial as well as your less beneficial gut bacteria.  
9. Proton Pump Inhibitors (PPIs) –  there is good research that people who rely on these drugs have less gut bacterial diversity and greater vulnerability to gut problems.
10. Hormonal birth control – Studies have shown oral contraceptives can negatively impact gut flora, which can increase inflammation and gut permeability, boosting IBS risk
11. NSAIDs and antidepressants –both these categories of drugs can decrease diversity of the bacteria in your gut, increasing infection risk and the chances of developing a leaky gut (especially NSAIDs).
12. Lack of bacterial diversity – a gut bacterial community that lacks diversity, because of genetics, cesarean section births, lack of breast feeding or any one or more of the culprits on this list, is less able to defend against pathogens and more likely to overreact to stuff which wouldn’t sicken someone else with a more diverse microbiome.

Step off the IBS symptom roller coaster.

Instead of trying to drug IBS into submission, I recommend going the holistic route which incorporates not only lifestyle upgrades, but also anti-microbial herbs and gut-friendly supplements to help balance the microbiome, tame symptoms, heal leaky gut, and boost gut function as a whole. I have found anti-microbial herbs to be effective and gentler on the microbiome (and rest of the body), especially when compared to the heavy pharmaceutical artillery many doctors are only too happy to bombard their patients with.

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My protocols will often include a combination of different supplements depending on the particular situation:

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• Mixed anti-microbials using a variety of herbs including berberine sulfate, olive leaf extract, oregano oil, grapefruit seed extract, sweet wormwood extract or artemisinin, bearberry extract, tribulus extract, black walnut hulls, thyme oil.
• Nutrients to support the gut lining like L-glutamine, zinc, fish oils, collagen or bone broth, and curcumin.
• Sometimes (usually at a later stage) broad spectrum probiotics to populate or repopulate the gut with a variety of helpful strains

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As for the lifestyle upgrades, a customized dietary prescription will provide additional support to help heal and seal the gut, often incorporating one or more of the following approaches:

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• An elimination diet, to remove the foods that could be irritating the gut and to help identify any food sensitivities or allergies that may be triggering or exacerbating IBS symptoms
• A low carb diet, with plenty of cooked non-starchy veggies
• A low FODMAP diet, which can be helpful to treat symptoms, and limit gas and bloating.

Protect with gut-supportive habits that will send IBS packing.

Getting your gut in order after it’s taken a beating from IBS won’t happen overnight, but once anti-microbial supplements and dietary approaches are in place, the next step is to protect your bacterial balance with healthy lifestyle behaviors. I cannot stress enough how important it is to put in the work, to make your life more manageable now and lay the foundation for a robust old age. The simplest and easiest-to-address behaviors start with what you put in your body – and what you don’t. On the list of items to purge ASAP:

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1. Keep sugar and starches to an absolute minimum – as they feed the overgrowth of bad bacteria in the small intestine and starve good bacteria in the colon, potentially setting you up for leaky gut.
2. Get rid of gluten – as sensitivities and allergies to it increase irritation of the gut wall, leading to permeability, inflammation, and debilitating IBS symptoms.
3. Rid the pantry of processed foods – which, convenient as they may be, are loaded with gut-irritating additives and devoid of the all-important fiber a gut in trouble needs.
4. Redline sweeteners – aspartame, fructose, lactose, sorbitol, xylitol, even honey and agave, all can make IBS matters worse (though some patients are able to use stevia and monk fruit without exacerbating problems).
5. Eat the rainbow – variety is the spice of life, and it’s great for your gut health too – as the nutrients and fiber in (low-sugar) fruit and non-starchy veggies across the color spectrum feed and nurture a variety of microbial species.
6. Cut the cocktails – as in, completely, especially if IBS is making life miserable. Like it or not, alcohol is a toxin that alters the microbiome and inhibits digestive enzyme production, which not only makes it harder to digest and absorb nutrients from food but also inflames your gut. So, the less you drink, the less risk of bacterial overgrowth and dysbiosis.
7. Curb your meds whenever possible – be they over-the-counter or prescription, many everyday meds can throw off your bacterial balance, encourage the bad guys to thrive and trigger symptoms. If however, meds are unavoidable, work with your doc to keep the dosages to an absolute minimum and follow my prescription for repairing a troubled gut.

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And on the must-add list:

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1. Ramp up your fiber intake – working your way up to about 40 grams per day.
2. Pour on tasty spices – which on their own or in combination can create positive alterations in the composition of gut microflora.
3. Add more polyphenols to your plate – your gut microbes love polyphenols, so keep them well-supplied with healthy goodies like nuts, berries, coffee, tea and olive oil.
4. Have a scoop of fermented foods – as they contain live microbes that help repopulate your gut with every bite.

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In addition to what you put in your body, how you care for it also makes a difference in how often IBS flares up or not. To help keep those symptoms from interfering with your day-to-day life, think:

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• Good, restful sleep – too little or poor sleep disrupts your natural circadian rhythms, leading to changes in gut permeability, and reductions in beneficial bacteria – so start pulling your sleep act together, stat!
• Stress reduction – a stressed-out body and mind will negatively impact the diversity of the bacteria in your gut, as well as the other microorganisms that live there, and trigger inflammation, so tame stress with a simple meditation practice to help stop flare-ups before they start.
• Move more – to help increase the numbers of good bacteria in your gut, and positively modify gut microbiome while also helping to keep inflammation at bay. Just don’t over-do it. According to a recent study, excessive exercise was shown to have a negative impact on gut bacteria.

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How else to get your gut in order and send IBS symptoms packing? Check out my in-depth look at How to Heal Leaky Gut and Repair the Gut Lining.